Eye-Hand Coordination in Elderly Stroke Victims: A Functional Visuomotor Rehab St

描述（由申请人提供）：中风是老年人残疾的主要原因，运动恢复的机制尚不清楚。康复治疗中一个被忽视的组成部分是清楚地了解眼手协调，即使眼睛和手的运动是大多数功能活动所必需的。更令人担忧的是，老年人的视力障碍非常普遍，并且在很大程度上未被发现，目前用于筛查老年人的方法缺乏灵敏度和特异性;不幸的是，当中风后视力丧失时，对ADL有显着影响，并且是依赖性的独立风险因素。本研究的目的是了解如何将眼训练推广到老年人的手臂训练，以提高眼手协调和功能表现。这项研究建议背后的具体假设是，眼睛控制先于手臂控制;我们提出，轻偏瘫患者在眼睛运动的规划和控制方面存在认识不足的缺陷，影响手臂运动的规划和控制，这是一个严重的事实，当被老化的视觉系统放大时，失去了空间和时间性能。在简单的物体检索任务中，眼睛运动或扫视在手臂运动或到达之前完成。在达到，中风患者表现出实质上更多的偏离直线路径比健康受试者，尽管使用更保守的策略和广泛的反馈控制。无效的扫视会增加眼外神经运动噪声，限制手臂运动的计划和执行。已经表明，健康的个体使用各种策略来计划伸展运动，但并非所有策略都同样有效。目前尚不清楚的是，眼球运动是否也是如此，以及训练更有效的策略是否可以推广到肢体运动，从而改善中风后的功能。对有效的眼科规划的清晰理解可以转化为功能性视力康复干预，以改善ADL。其中一种方法可能是在电子游戏的设计中促进更有效的视觉策略和眼手协调。本研究的总体目标是更好地阐明老年人的视觉规划策略，这些策略可以在老年人和中风后老年人中实施，以促进长期功能恢复 公共卫生相关性：手眼协调将被证明对我们的老龄化人口至关重要，因为我们的正常视觉系统在时间和空间上失去了各个方面;视力丧失问题和中风，额外的合并症和视力障碍的潜在额外原因，都对老年人口中的残疾有重大影响。中风相关的视觉缺陷与日常活动受限、福尔斯风险增加有关， 并阻碍康复进展;与社区对照受试者相比，非住院长期卒中幸存者经常发生福尔斯。视力以外的视觉功能可能会影响老年人的日常功能;这些更高层次的眼运动规划功能是我们在这项研究中对年轻人和老年人有和没有中风的特点。

DESCRIPTION (provided by applicant): Stroke is a leading cause of disability in the aged and the mechanisms underlying motor recovery are not well understood. A neglected component in rehabilitative therapies is a clear understanding of eye-hand coordination even though eye and hand movement is necessary for most functional activities. Of more concern is the fact that vision impairment in the aged is highly prevalent and largely undetected and the current methods used to screen the elderly lack sensitivity and specificity; unfortunately when one adds vision loss after stroke there is a significant impact on ADLs and an independent risk factor for dependency. The purpose of this project is to understand how eye training can be generalized to arm training in the elderly to improve eye-hand coordination and functional performance. The specific hypothesis behind this research proposal is that eye control precedes arm control; we propose that patients with hemiparesis have under-recognized deficits in the planning and control of eye movement that affects the planning and control of arm movement, a grave fact when amplified by the aging visual system, losing spatial and temporal performance. During simple object retrieval tasks, eye movements or saccades are completed prior to arm movements or reaches. During reaching, stroke patients demonstrate substantially more deviation from straight-line paths than do healthy subjects, despite using more conservative strategies and extensive feedback control. Inefficient saccades could increase extraocularneuromotor noise, limiting the planning and execution of arm movements. It has been shown that healthy individuals use various strategies to plan reaching movements, but not all of them are equally efficient. What is not known is whether the same is true for eye movements, and whether training the more efficient strategy can generalize to limb movements for reaching, yielding functional improvement post-stroke. A clear understanding of efficient oculomotor planning may translate into functional vision rehabilitation interventions to improve ADLs. One such approach may be in the design of videogames to promote more efficient oculomotor strategies and eye-hand coordination. The overarching goal of the present study is to better elucidate the visuomotor planning strategies in the elderly that may be implemented both in the elderly and in the elderly post-stroke to foster long-term functional recovery PUBLIC HEALTH RELEVANCE: Eye-hand coordination will prove critical for our aging population, as our normal visual system loses aspects temporally and spatially; vision loss problems and stroke, an additional co-morbidity and a potential additional cause of vision impairment, both have major impacts on disability within an elderly population. Stroke related visual deficits are associated with limitations in performing daily tasks, increased risk of falls, and impeded rehabilitative progress; falls are frequent among non-institutionalized long-term stroke survivors when compared to their community control subjects. Vision functions other than visual acuity may be affecting the daily function of older adults; these higher-level eye motor planning features are what we propose to characterize in this study on young adults and elderly with and without stroke.